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381. Multimorbidity: a priority for global health research

strategies for multimorbidity 60 5.3 Better models of healthcare for treating patients with multimorbidity 63 Acronyms 72 Glossary of terms 73 Annex 1: Project conduct and timeline 75 Annex 2: Membership of the working group, secretariat, and review group 76 Annex 3: Helpful resources 81 Annex 4: Clustering of conditions 82 Annex 5: Clustering of mental and physical health conditions 83 Annex 6: Sex as a determinant of multimorbidity 85 Annex 7: Ethnicity as a determinant of multimorbidity 87 Annex 8 (...) observed in those with a single condition. There are also very few data about the effectiveness of health services and systems for patients with multimorbidity. In most parts of the world, large components of the health system are designed around single conditions or body systems. This focus extends to the training of doctors, particularly those working in hospitals where subspecialisation is now common, leaving the coordination of care for patients with multiple chronic conditions to general

2018 Academy of Medical Sciences

382. Chronic kidney disease

, and providing the decrease in eGFR is 40% reduction in non-HDL cholesterol is not achieved. A renal specialist should be consulted if higher doses are required for patients with a eGFR 20%), increased length of hospital stay, and incomplete recovery of kidney function (many patients will be left with CKD). AKI and CKD are complex interconnected syndromes; CKD increases the risk of AKI and an episode of AKI increases the likelihood of subsequent development of CKD. Although AKI is common in hospitalised (...) for developing CKD after AKI is long-term and increases with increasing severity of AKI. 16 It is important to ensure appropriate follow-up and patient education. Patients should be monitored for the development or progression of CKD for at least two to three years after AKI, even if serum creatinine has returned to baseline. 2 A plan to carefully re-introduce or re-titrate necessary medicines that were withheld during the acute illness should be discussed with the patient together with the risk of recurrent

2018 WeMeReC

383. Paediatric European Network for Treatment of AIDS (PENTA) guidelines for treatment of paediatric HIV-1 infection 2015: optimizing health in preparation for adult life

for resource-rich and resource-poor settings is available from recently updated US [4] and World Health Organi- zation (WHO) [6] paediatric guidelines. Special considera- tions for children in resource-limited settings where background rates of concomitant infections and malnu- trition are much higher are not considered here, and the reader is referred to WHO guidelines. Differences from the WHO and US Department of Health and Human Services (DHHS) guidelines will be referred to where relevant (...) regimens. 7. Adherence and HIV knowledge • Adherence to treatment is paramount and should be discussed at each clinic visit. • Every effort should be made to simplify a regimen to support adherence (e.g. using once-daily regimens, FDCs, and‘forgiving’regimenswithhigherbarrierstoresistance). Simple adherence aids should be used when appropriate. 4 A Bamford, et al. © 2015 The Authors. HIV Medicine published by John Wiley & Sons Ltd on behalf of British HIV Association HIV Medicine (2015)• Children

2018 The Children's HIV Association

384. Accountable care organisations

, Julien Mosques, Tracy Johnson, and Daniel Northam-Jones). April 2018 © Sax Institute 2018 This work is copyright. It may be reproduced in whole or in part for study training purposes subject to the inclusions of an acknowledgement of the source. It may not be reproduced for commercial usage or sale. Reproduction for purposes other than those indicated above requires written permission from the copyright owners. Enquiries regarding this report may be directed to the: Principal Analyst Knowledge (...) a specified population for which providers are jointly accountable • Performance — determining target outcomes for the specified population, including resource use • Metrics and learning — developing and refining metrics to help determine whether outcomes are improving and to learn from these measurements and variations in results • Payment and incentives — restructuring payments and other incentives to align with the target outcomes, including details of risk-sharing arrangements • Coordinated delivery

2018 Sax Institute Evidence Check

385. The Patient Centred Medical Home: barriers and enablers to implementation

to specific populations 59 Additional enablers supporting the implementation of the PCMH 66 General 66 Education programs 67 Practice facilitation/ coaching 68 Learning collaboratives 69 Learning resources/ ‘toolkits’ 70 Performance measurement and feedback 70 Roles incorporated into primary care to support PCMH functions 71 Enablers for Indigenous populations 74 Gaps in the evidence 74 Discussion of findings 76 Applicability 78 Conclusion 79 References 80 Appendix 1: Literature selection process 88 (...) of care General strategies: Education programs Practice facilitation/coaching Learning communities/collaboratives Learning resources/’toolkits’ New/ enhanced roles: Medical practice assistant Community health workers Embedded pharmacists Integrated community specialists 3. Care coordination beyond the practice 3. Care coordination beyond the practice • Partnerships with community providers • Linkages with specialty and hospital care • Information sharing and continuity of care 4. Health information

2018 Sax Institute Evidence Check

386. Recommendation on screening adults for asymptomatic thyroid dysfunction in primary care

were blood pressure, bone mineral density, cholesterol and weight change. We also used the GRADE approach to determine the certainty of the evidence and strength of the recommendation ( ). Appendix 2 (available at ) provides the evidence-to-decision framework that the task force used to assess the balance between benefits and harms, patient values, resource use, feasibility, acceptability and equity in order to develop the recommendation. The entire task force reviewed and approved (...) and facilitate implementation of guidance, based on feedback from clinician knowledge users. One reason for this change was the value that the task force places on shared decision-making, together with a need to clarify better when implementation of a recommendation depends on circumstances such as patient values, resource availability or other contextual considerations. Conditional recommendations based on patient values and preferences require clinicians to recognize that different choices

2019 Canadian Task Force on Preventive Health Care

387. Managing health and wellbeing in the workplace

. mission statement), (ii) connecting the vision to organisational values, strategy, practice and policy (i.e. build a health culture); (iii) gaining budget and resource commitment, (iv) educating and engaging senior management; (v) sharing the vision with employees, (vi) serving as a role model (‘walk the talk’), (vii) ensuring accountability and responsibility (for instance, KPI’s for senior management), (viii) rewarding success (for example, incentives, public recognition), (ix) adapting the program (...) Managing health and wellbeing in the workplace Managing health and wellbeing in the workplace An Evidence Check rapid review brokered by the Sax Institute for SafeWork NSW. January 2018. An Evidence Check rapid review brokered by the Sax Institute for SafeWork NSW. January 2018. This report was prepared by: Bill Bellew Consulting Associates January 2018 © Sax Institute 2018 This work is copyright. It may be reproduced in whole or in part for study training purposes subject to the inclusions

2018 Sax Institute Evidence Check

388. Access to Hormonal Contraception

, limitations of available resources, or advances in knowledge or technology. The American College of Obstetricians and Gynecologists reviews its publications regularly; however, its pub- lications may not reflect the most recent evidence. Any updates to this document can be found on or by calling the ACOG Resource Center. While ACOG makes every effort to present accurate and reliable information, this publication is provided “as is” without any warranty of accuracy, reliability, or otherwise (...) - tinued their pill use (P5.12) (20). Additionally, when adjustingfordifferences(age,countryofbirth,country where education was completed, U.S. health insurance status, receipt of government assistance, border- crossing frequency, duration of use of OCPs, experi- ence of adverse effects attributable to OCPs, and how long the woman reported she planned to use OCPs), a higher rate of discontinuation for women who ob- tained pills in El Paso clinics (25.1%) compared with those who obtained their pills

2019 American College of Obstetricians and Gynecologists

389. American Society for Parenteral and Enteral Nutrition Clinical Guidelines: The Validity of Body Composition Assessment in Clinical Populations Full Text available with Trip Pro

muscle IMAT (area), paraspinal IMAT (area), and psoas IMAT (area) (CT) Time between body composition cholesterol, tests not stated Spearman correlations reported There were significant correlations between % BF (DXA) and VAT (area), SAT (area), abdominal muscle IMAT (area), paraspinal IMAT (area), and psoas IMAT (area) (CT) (all P ‐values < 0.0001) Mourtzakis et al, 2008 To evaluate regional CT images acquired during routine patient care as a potential resource to discriminate and to quantify (...) centered on key questions, planned data acquisition, and conflation (ie, merging) of their findings by reviewing pertinent randomized clinical trials (RCTs) and/or observational studies that addressed the focus area and relied on the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. Previous guidelines employed GRADE and converged specific data points from RCTs and/or observational studies to guide their recommendations. The current guideline did not limit potential

2019 American Society for Parenteral and Enteral Nutrition

390. Sudden Hearing Loss Full Text available with Trip Pro

presents with sudden hearing loss. (KAS 7) Clinicians should educate patients with sudden sensorineural hearing loss about the natural history of the condition, the benefits and risks of medical interventions, and the limitations of existing evidence regarding efficacy. (KAS 13) Clinicians should counsel patients with sudden sensorineural hearing loss who have residual hearing loss and/or tinnitus about the possible benefits of audiologic rehabilitation and other supportive measures. These strong (...) of treatment and also within 6 months posttreatment is added. KAS 13—This statement on audiologic rehabilitation includes patients who have residual hearing loss and/or tinnitus who may benefit from treatment. Addition of an algorithm outlining KASs Enhanced emphasis on patient education and shared decision making with tools provided to assist in same Keywords , , , , , Introduction Sudden hearing loss (SHL) is a frightening symptom that often prompts an urgent or emergent visit to a clinician

2019 American Academy of Otolaryngology - Head and Neck Surgery

391. Methodology for Creating Expert Consensus Decision Pathways

. As a result of these recommendations, the publications previouslyknownas“ExpertConsensusDocuments”were rebranded as “Expert Consensus Decision Pathways.” Expert Consensus Decision Pathways function as a com- plement to the knowledge provided by Clinical Practice Guidelines. If Guidelines are the “why” of treatment, the Expert Consensus Decision Pathways provide “the how”: 1. Practical guidance for transforming guideline recom- mendations into clinically actionable information (the “how”), 2 (...) , and tobacco cessation (1–8); currently, the scope of Expert Consensus Decision Pathways is widening to include the development of guidance on the management of conduction distur- bances for TAVR and same-day discharge after PCI, as well as various other topics. As ACC continues to drive its vision of “aworldwhere innovation and knowledge optimize cardiovascular care and outcomes” (9), the process for developing Expert Consensus Decision Pathways has evolved to accommo- date the rapid translation

2019 American College of Cardiology

392. Integrated care for older people (?ICOPE)?: guidance for person-centred assessment and pathways in primary care

(University of Stirling, United Kingdom), Leocadio Rodriguez-Mañas (University Hospital of Getafe, Spain), John Starr (University of Edinburgh, United Kingdom), Kelly Tremblay (University of Washington, United States of America), Michael Valenzuela (University of Sydney, Australia), Bruno Vellas (WHO Collaborating Centre for Frailty, Clinical Research and Geriatric Training, Gérontopôle, Toulouse University Hospital, France), Marjolein Visser (Vrije Universiteit Amsterdam, the Netherlands), Kristina (...) Zdanys (University of Connecticut, United States of America), and the WHO Collaborating Centres for Frailty, Clinical Research and Geriatric Training (Gérontopôle, Toulouse University Hospital, France) and for Public Health Aspects of Musculoskeletal Health and Aging (University of Liège). Australian National Health and Medical Research Council, Global Alliance for Musculoskeletal Health and Chulalongkorn University, Thailand, supported the development of this guidance by providing staff to develop

2019 World Health Organisation Guidelines

393. Management of Stroke Rehabilitation

- specific goals, values, and preferences. B. Guide patients on self-management during stroke rehabilitation as well as on use of other resources that are available to assist them with their ADLs. C. Assist patients with navigating the complex health system. D. Provide patients and family, and their caregivers with education and health information to improve understanding of stroke, common comorbidities, and stroke rehabilitation management. Materials need to be individualized to preferred learning (...) comprehensive care and rehabilitation starting early in the post-acute phase. G. Create a support system for patients with stroke and their caregivers. Suggested actions include monthly provider-facilitated meetings either in-person or online groups, other support groups, and stroke education classes to enhance involvement and support among patients with stroke. H. Screen for, identify, and treat post-stroke depression. I. Provide home care and community support resources to optimize quality of life

2019 VA/DoD Clinical Practice Guidelines

394. Management of Acute ST Segment Elevation Myocardial Infarction (STEMI) – (4th Edition)

to specialists, general practitioners were also included. Patient and carer groups were however not included as external reviewers. Objectives These guidelines are intended to provide awareness and education in order to reduce the morbidity and mortality associated with STEMI by: • Reducing total ischaemic time • Developing a network for early referral and treatment of STEMI patients • Updating the management of STEMI with respect to:  Diagnosis  Management  Secondary prevention MANAGEMENT OF ACUTE ST (...) chest pains but with a non interpretable ST- segment on the ECG, such as those with bundle branch block (assumed new onset RBBB ) or ventricular pacing, may be having a MI and may be considered for a PCI strategy depending on resources. IIa,A. There is no role for fibrinolysis in these patients. • Radial access is recommended over femoral access if performed by an experienced radial operator. I,A • Stenting is recommended (over balloon angioplasty) for primary PCI. I,AMANAGEMENT OF ACUTE ST SEGMENT

2019 Ministry of Health, Malaysia

395. Management of Heart Failure (4th Edition)

to keep abreast with recent developments and knowledge that is being learnt.11 Applicability of the Guidelines and Resource Implications: This guideline was developed taking into account our local health resources. Blood investigations, chest radiographs, ECGs and echocardiograms are common in almost all public health facilities. The drugs used to treat HF - diuretics, ACE-I, ß-blockers have been approved for use in Malaysia and available in public hospitals as generics. This guideline aims to educate (...) health care professionals on strategies to optimise existing resources in the timely management of patients with HF. Facilitators and Barriers: The main barrier for successful implementation of this CPG is the lack of knowledge of healthcare providers in the: ? Diagnosis of HF. ? Management of HF - initial treatment and long term follow-up. ? Optimisation of therapy and when to refer to tertiary centres. Implementation of the Guidelines: The implementation of the recommendations of a CPG is part

2019 Ministry of Health, Malaysia

396. Obesogenic environment evidence review technical report

. [Data extraction table] 4. Dadpour S et al. Understanding the influence of environment on adults' walking experiences: a meta-synthesis study. Int J Environ Res Public Health 2016; 13: 731. [Data extraction table] 27 | P a g e 3.1.13 Promotion of parks and urban green space Environment type: Sociocultural/Physical Environment size: Micro Directional thinking Limits to what we know Other things to consider Evidence about the effectiveness of training and resourcing of park managers to promote (...) to the UK. ? Only one of the studies investigating promotion of urban green space alongside development of, or improvement of facilities used a control group and systematic review authors noted that this study had an unclear risk of bias 1 . ? The single randomised controlled trial which investigated effects of training and resourcing park managers to promote physical activity within urban green space was assessed by systematic reviewers as being of low risk of bias and showed a significant increase

2019 Public Health Wales Observatory Evidence Service

397. Achieving Health Equity in Preventive Services

, and provider training; and those using community resources through partnerships or outreach, such as patient navigators in the community, lay health workers, telephone or mail contacts, patient education, and engagement with community resources. Study populations included racial and ethnic minority groups including Hispanic, African-American, and Asian; and rural and low-income patients. Fifty studies (in 53 publications) evaluated the effectiveness of interventions to improve colorectal cancer screening (...) was strongest for patient navigation to increase screening for colorectal (risk ratio [RR] 1.64; 95% confidence interval [CI] 1.42 to 1.92; 22 trials), breast (RR 1.50; 95% CI 1.22 to 1.91; 10 trials), and cervical cancer (RR 1.11; 95% CI 1.05 to 1.19). Screening was also higher for colorectal cancer with telephone calls, prompts, other outreach methods, screening checklists, provider training, and community engagement; breast cancer with lay health workers, patient education, screening checklists

2019 Effective Health Care Program (AHRQ)

398. Global Vascular Guidelines for patients with chronic limb-threatening ischemia Full Text available with Trip Pro

lipoprotein cholesterol LMICs Low- and middle-income countries LS Lumbar sympathectomy MACE Major adverse cardiovascular event MALE Major adverse limb event MRA Magnetic resonance angiography OPG Objective performance goal PAD Peripheral artery disease PBA Plain balloon angioplasty PFA Profunda femoris artery PLAN Patient risk estimation, limb staging, anatomic pattern of disease PROM Patient-reported outcomes measure PSV Peak systolic velocity PT Posterior tibial PVR Pulse volume recording RCT Randomized (...) comparative effectiveness research, identifying critical gaps in knowledge, and developing effective algorithms for treatment. CLTI represents a broad range of clinical severity (limb threat) and anatomic complexity of disease. The GVG incorporates the SVS Lower Extremity Threatened Limb Classification System x 10 Mills, J.L. Sr., Conte, M.S., Armstrong, D.G., Pomposelli, F.B., Schanzer, A., Sidawy, A.N. et al. The Society for Vascular Surgery Lower Extremity Threatened Limb Classification System: risk

2019 Society for Vascular Surgery

399. Long-Term Drug Therapy and Drug Holidays for Osteoporosis Fracture Prevention: A Systematic Review

information, i.e., in the context of available resources and circumstances presented by individual patients. This report is made available to the public under the terms of a licensing agreement between the author and the Agency for Healthcare Research and Quality. This report may be used and reprinted without permission except those copyrighted materials that are clearly noted in the report. Further reproduction of those copyrighted materials is prohibited without the express permission of copyright (...) are essential to the Effective Health Care Program. Please visit the website ( to see draft research questions and reports or to join an email list to learn about new program products and opportunities for input. If you have comments on this systematic review, they may be sent by mail to the Task Order Officers named below at: Agency for Healthcare Research and Quality, 5600 Fishers Lane, Rockville, MD 20857, or by email to Gopal Khanna, M.B.A. Director

2019 Effective Health Care Program (AHRQ)

400. Treatment of Diabetes in Older Adults Full Text available with Trip Pro

of diabetes and its complications on overall health status ( , ), many older patients benefit from care by an interdisciplinary team. The endocrinologist or diabetes care specialist functions as the leader of the diabetes care team, which includes a nurse educator, dietician, and others ( e.g. , pharmacist, psychologist, social worker). The endocrinologist or diabetes care specialist may also serve the medical community by providing up-to-date training in the care of older patients with diabetes. Possible (...) remark: This recommendation is most applicable to high-risk patients with any of the following characteristics: overweight or obese, first-degree relative with diabetes, high-risk race/ethnicity ( e.g. , African American, Latino, Native American, Asian American, Pacific Islander), history of cardiovascular disease, hypertension (≥140/90 mm Hg or on therapy for hypertension), high-density lipoprotein cholesterol level <35 mg/dL (0.90 mmol/L) and/or a triglyceride level >250 mg/dL (2.82 mmol/L), sleep

2019 The Endocrine Society

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